IHD
Summary
IHD (ischemic heart disease), also called coronary artery disease, is the chronic syndrome of myocardial oxygen demand exceeding supply due to atherosclerotic narrowing of the coronary arteries. It encompasses stable angina, acute coronary syndromes (UA, NSTEMI, STEMI), ischemic cardiomyopathy, and sudden cardiac death.
Detail
Risk factors: age, male sex, smoking, hypertension, diabetes, dyslipidemia (high LDL/low HDL), family history, obesity, sedentary lifestyle. Pathology: progressive atherosclerotic plaque builds up in coronary arteries; flow becomes limiting at >70% luminal stenosis, producing exertional (stable) angina relieved by rest or nitroglycerin. Plaque rupture causes ACS. Diagnostic workup: resting ECG, stress testing (exercise or pharmacologic with dobutamine/regadenoson, with ECG or imaging via echo/SPECT), coronary CTA, and gold-standard invasive coronary angiography. Treatment of stable IHD: lifestyle modification, high-intensity statin, antiplatelet (aspirin), beta-blocker, nitrates for symptoms, and revascularization (PCI or CABG) for refractory symptoms or high-risk anatomy (left main, three-vessel disease, especially with diabetes, where CABG outperforms PCI per SYNTAX/FREEDOM trials). Long-standing IHD is a leading cause of heart failure with reduced ejection fraction.
Sources
- First Aid for USMLE Step 2 CK 2024
- Harrison's Principles of Internal Medicine
- Robbins Basic Pathology 10th ed
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